Hemithyroidectomy alone versus completion thyroidectomy in patients with papillary thyroid carcinoma and pathological central nodal disease (pN1a): A retrospective cohort study.

BACKGROUND: The optimal extent of surgery for papillary thyroid carcinoma (PTC) with pathologically confirmed central nodal metastasis (pN1a) remains debatable, particularly in an era of surgical de-escalation. This study aimed to compare the outcomes of hemithyroidectomy alone versus hemithyroidectomy followed by completion thyroidectomy in patients with pN1a PTC. METHODS: A retrospective study was performed. Patients who underwent hemithyroidectomy for PTC with pN1a disease from 2001 to 2023 were reviewed. Patients were stratified by whether they subsequently underwent completion thyroidectomy. Demographic, surgical and oncological outcomes were compared. RESULTS: A total of 29 patients were included: 21 in the hemithyroidectomy-alone group and 8 in the completion thyroidectomy group. The completion thyroidectomy group was significantly older (56.6 ± 19.4 vs. 39.4 ± 13.7 years; p = 0.012) and had a higher ATA 2025 risk category (p = 0.040). The complication rate was significantly higher in the completion thyroidectomy group (62.5% vs. 14.3%; p = 0.019). At a mean follow-up of 144 months, there was no structural recurrence or disease-related mortality in either group. In the completion thyroidectomy group, 7 of 8 patients (87.5%) achieved undetectable serum thyroglobulin following RAI ablation; one patient had persistently detectable thyroglobulin (3.4μg/L) with a negative diagnostic I-131 scan and no structural recurrence identified. CONCLUSION: In selected patients with pN1a PTC, hemithyroidectomy alone appears to achieve durable locoregional control with lower morbidity compared with completion thyroidectomy. These findings support a conservative surgical approach for low- to intermediate-risk pN1a PTC.